Certain aspect of reproductive behaviour such as maternal age and parity at the time the child is born has long been thought to affect the mother’s survival.There is evidence that the risk of maternal mortality is higher for women under the age 20 and over the age 35 and for parity 0 and very high parity .
A typical U.S. woman is fertile about 40 years — half of her expected lifespan. If you choose not to have children at any point during that time, it's important that you select a birth control method that you find comfortable and appealing to your lifestyle.
The relationship between maternal death, age and parity might result from underlying biological factors: very young women’s reproductive system may not be prepared adequately to the stress of the pregnancy, while advanced aging might reduce the efficiency of the entire reproductive process.Whereas first birth might be riskier as the body goes through parturition for the first time, and higher parity may be a greater risk due to exhaustion of the body. The real effect of parity and age in fact may not be an entirely biological effect but may be due to other confounding factors viz. socio-economic status, which needs to be explored. Clearly age and parity are interrelated, as young mothers tend to have less parity.
Birth control pills (oral contraceptives) are a method of birth control that uses hormones to prevent pregnancy. The man-made female hormones in the pills change a woman's natural hormone levels and prevent her ovaries from releasing an egg each month. The hormones also help prevent pregnancy in 2 other ways. They cause a thickening of the mucus on the cervix and they change the lining of the uterus. The thickened mucus on the cervix makes it hard for sperm to enter the uterus. The change in the lining of the uterus helps prevent a fertilized egg from attaching to the uterus.
THE pill was the first effective hormonal contraceptive method to come on the market and soon became a very popular means of fertility control. Researchers and manufacturers have since developed new delivery systems for hormones: injectables, implants, IUDs and rings.The acceptability of the hormonal contraceptive methods used most extensively in family planning programmes worldwide.
Women going through the transitional phase of perimenopause may need help dealing with the body's reaction to the slightly decreased levels of the ovarian hormone estrogen. Oral contraceptives are increasingly being considered to fulfill this role. Even though the use of oral contraceptives in this way has not been approved by the FDA, it has been scientifically proven that these contraceptives also offer several additional health benefits beyond birth control for the perimenopausal woman.
The timing of sexual intercourse in relation to ovulation strongly influences the chance of conception, although the actual number of fertile days in a woman's menstrual cycle is uncertain. The timing of intercourse may also be associated with the sex of the baby.
Oral contraceptives (OCs) are available only by prescription and come in either a combination of estrogen and progestin or progestin alone.Combination pills are sold in 21-day or 28-day packs:
* Each pill in a 21-day pack contains estrogen and progestin. Women take 1 pill a day for 21 days, and then wait 7 days before starting a new 21-day pack.
* 28-day packs typically start with 21 hormone pills and add 7 placebo pills that do not contain hormones. After taking hormone pills for 21 days, a woman takes the inactive pills for 7 days. Some newer brands, like Yaz, use 24 days of active pills and 4 days of inactive pills. Mircette uses 21 days of low-dose progestin and estrogen, followed by 2 placebo days, and then 5 days of very low-dose estrogen. Loestrin 24 Fe uses 24 days of active pills followed by 4 days of iron-containing placebo pills.
In contrast, the U.S. Food and Drug Administration (FDA) approved a new birth control pill that you take for 12 weeks. During the 13th week, you have a period. This pill (brand name: Seasonale) reduces the number of periods from one a month to about one every three months.As always, when looking at birth control, keep in mind that any method only works if you use it consistently and correctly.
There are a lot of advertisements talking about birth control options or contraceptive pill options that shorten the menstrual cycle and even suppress the menstrual cycle for three months at a time, and we as gynecologist have been doing this for years, using hormonal contraception for other things than just contraception; for treating women with painful periods, heavy periods, women with irregular periods, women with premenstrual symptoms
Emergency contraception is not usually indicated when one or more oral-contraceptive pills have been forgotten, because there are established and effective rules for the use of a barrier method as secondary prevention under these circumstances" could be misinterpreted. The reason most women need emergency contraception is that they have not followed "established and effective rules" for regular — or back-up — contraception. For example, in a recent study of 103 women taking oral-contraceptive pills, back-up contraception was used in only 3 percent of the acts of intercourse in which it was indicated. In addition, that statement diverts attention from a situation in which emergency contraception may prevent a pregnancy that would otherwise result from an act of intercourse before the pills were missed (e.g., an active pill is taken on schedule on Saturday night, intercourse occurs on Sunday evening, and active pills are missed on Sunday, Monday, and Tuesday nights).
In fact, with the spread of AIDS and other STDs, latex condoms may have a greater role in disease prevention than in contraception. Condoms are almost synonymous with safe sex. In any nonexclusive sexual relationship — or in any relationship in which one partner's HIV status is unknown — you should automatically be using a condom, even if your partner is on the pill or using another form of contraception.
A new year-round contraceptive pill called Lybrel, which eliminates menstrual cycles altogether, appears to be safe and effective, researchers report.One advantage to using this pill is that you take one pill regularly with the expectation that you are not going to have a regular menstrual bleeding period.So, this is a group of women who are going to be willing to put up with that type of nuisance bleeding.Another benefit to this pill is the elimination of menstrual cycle-related symptoms, such as mood changes, menstrual cramps and headaches.
Recently this Lybrel, a birth-control pill that does away with a woman's monthly period, was approved by the U.S. Food and Drug Administration.
The estrogen-progestin hormonal pill differs from traditional birth-control pills in that it does not include the "week off" of placebo pills that leads to a cessation of artificial hormones and bleeding.
Lybrel is described as "continual contraception" but it "works the same way as the 21-days on, seven-days off [pill] cycle -- it stops the body's monthly preparation for pregnancy by lowering the production of hormones that make pregnancy possible," Dr. Daniel Shames, deputy director of the FDA's Office of Drug Evaluation III, at the Center for Drug Evaluation and Research, explained at a press conference .
A majority of women who decide to take Lybrel will encounter unscheduled bleeding, or spotting, that in most cases tapers off over the first year of use, Shames said. In the primary clinical trial leading up to approval, 59 percent of women who took Lybrel for one year reported no bleeding or spotting during the last month of the trial.
In terms of safety, two one-year clinical trials involving more than 2,400 18-to-49-year-old women showed no increased risk of endometrial cancer among those taking Lybrel. The risks of other side effects linked to the birth-control pill -- primarily blood clots -- were similar to those seen in other contraception regimens, Shames said.
"We don't expect any surprises in terms of long-term use of this product," he added, although he noted that the FDA has requested that the drug's maker, Wyeth Pharmaceuticals, conduct post-marketing studies to keep tabs on Lybrel's long-term safety.
Despite some women's reticence to do away completely with their monthly period, gynecologic experts agreed that there was no physiological "downside" to a period-free life. In fact, one expert noted that, for decades, many American women have been pharmaceutically ending their periods with more traditional birth-control pills with no resulting problems.
"There were other products, such as the long-acting progestin, Depo-Provera, that was given by injection," said Dr. Michael Petriella, vice chairman of obstetrics and gynecology at Hackensack University Medical Center, in Hackensack, N.J. "Women who were using that for contraception wouldn't get their period at all while on that product."
And for years, "some physicians have been allowing some women to take the Pill off-label -- allowing them to take two packages continuously, for example," Petriella said.
Another expert noted that the "period" women get while on conventional birth-control pills isn't connected to a natural cycle of egg production, anyway.
"It's not a natural period. It's an artificially induced period that happens because she stops taking the hormones for seven days. So, she gets some vaginal bleeding," explained Dr. Camelia Davtyan, an internist specializing in women's health and an associate professor of medicine at the University of California, Los Angeles.
In fact, a no-period pill like Lybrel could have been a contraceptive norm for women from the get-go, Davtyan said. However, the doctors and pharmaceutical companies who developed the birth-control pill back in the 1960s assumed that women would want a regimen that mimicked the monthly cycle.
"I guess they were trying to make it seem as 'real' as possible and cause as little change as possible in a woman's life," Davtyan said.
But times have changed, and newer contraceptive products such as Seasonale -- a contraceptive pill that cuts the number of periods to just four a year -- have already been readily embraced by some American women over the past decade.
Davtyan said she has recently noticed a big shift in her patients' attitudes toward their period.
"They want convenience, and they tell me that they'd just rather not have the bleeding altogether so that they don't have any limitations with sports, with having to use pads, tampons," she said. "And the younger the woman, the more likely that she will want her periods stopped. It's very possible that this will be the wave of the future."
But Petriella said many women still feel a strong psychological attachment to their period and do not want to give it up, however inconvenient it may be.
"Sometimes [ending periods] is just emotionally uncomfortable for women," he said. "They don't feel right about not having their period. For those women, obviously Lybrel and other such products are not good products for them."
Many gynecologists believe that the week without contraception – during which a woman experiences a “withdrawal bleed” that mimics the normal menstrual cycle – isn’t necessary. And while some debate surrounds the issue, numerous women are opting to take hormonal contraceptive products continually as a way of stopping the cycle entirely or for several months at a time.
Critics contend that too much remains unknown about the effects of menstrual suppression. Some say it prevents women from ridding their bodies of excess iron; that it is unnatural to suppress one’s cycle; and that more needs to be known about the effects on women’s bone health, heart health and cancer risks.
A recent survey by the Association of Reproductive Health Professionals found that 71 percent of women surveyed do not enjoy getting their period each month, and that just 36 percent of clinicians surveyed think the monthly period is something that women have to deal with.
Petriella believes that, at least in the short-term, Lybrel will appeal to only a minority of women. They include those with menstruation-linked conditions such as endometriosis and menstrual migraine, or those who have already tried -- and liked -- period-limiting products such as Seasonale, he said.
As with any pharmaceutical contraceptives, women who decide to go on Lybrel may experience random breakthrough bleeding, Davtyan said.
So, for the 59 percent of women who have no bleeding or spotting after one year, "I think Lybrel is a great deal," Davtyan said. "For the remainder, if they have the patience to hang in there for a few months, the spotting might abate. There will be an occasional patient that will continue to spot, and then, clearly, it's a better deal to have a scheduled period than to start spotting at an unknown time and maybe in an uncomfortable circumstance."
Women who decide to resume their monthly cycle -- for example, those who wish to become pregnant -- can typically expect to resume their normal cycle within days of stopping Lybrel, Shames said. He said that short timespan to resumption of ovulation could leave women who skip or miss pills open to unplanned pregnancy, so the FDA is advising that women consider a second form of birth control while on Lybrel, as a safeguard.
Both Davtyan and Petriella stressed that young women who are considering a pharmaceutical end to their period should not be concerned that doing so will harm their health.
"Remember, there's no real physiological value to hold on to the period that a woman has while she is taking the Pill, unless it is a psychological value, which I respect," Davtyan said.
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